Acute Inpatient Prospective Payment System (IPPS) Hospital - JE Part A

Section 1886(d) of the Social Security Act (the Act) sets forth a system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A (Hospital Insurance) based on prospectively set rates. This payment system is referred to as the inpatient prospective payment system (IPPS). Under the IPPS, each case is categorized into a diagnosis-related group (DRG). Each DRG has a payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG. CMS Acute Inpatient PPS

Access the below IPPS related information from this page.

• Admission Date and Statement Covers Period Billing
• Enrollment
• IPPS DRG Adjustment
• IPPS DRG Validation Review Process
• Inpatient Ancillary Services
• Inpatient Hospital Billing Guide
• Inpatient PPS Billing for Cost Outlier
• Part A to B Rebilling Guidance
• Pre-Entitlement Claims for Inpatient Hospitals
• Present on Admission Indicators
• Same Day Transfers

Resources

• CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 1 - Inpatient Hospital Services Covered Under Part A, Sections 10 and 50
• CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 3 - Duration of Covered Inpatient Services, Section 20
• CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 5 - Lifetime Reserve Days, Sections 20 and 30
• CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 2 - Admission and Registrations Requirements, Sections 10.6, 10.11, 30.19
• CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 3 - Inpatient Hospital Billing, Sections 10.5, 20.1.2.4, 40.2.5, 40.2.6, 40.3, 110